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General NPI Number Information
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NPI Number | 1396250015
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Entity Type | Organization
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Legal Business Name | TAUNTON ORTHODONTIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 36 WEIR ST
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City | TAUNTON
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State | MA
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Zip | 02780-3916
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Country | US
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Telephone | 508-588-6500
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Fax | 508-588-6030
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Provider Business Mailing Address
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Address Line | 450 N MAIN ST
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City | SHARON
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State | MA
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Zip | 02067-1172
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Country | US
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Telephone | 508-588-6500
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Fax | 508-588-6030
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Authorized Official
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Title or Position | OWNER
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Name | DR. OMAR SALEM
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Credential | DMD, MSD
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Telephone | 508-588-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 21358
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License Number State | MA
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